Evaluation of a Mapleson D CPAP system for weaning of mechanical ventilation in pediatric patients.

BACKGROUND: Over the last years, we have used a flow-inflating bag circuit with a nasotracheal or nasopharyngeal tube as an interface to deliver effective CPAP support in infants ("Mapleson D CPAP system"). The primary goal of this study was to assess the usefulness of the "Mapleson D CPAP system" for weaning of mechanical ventilation (MV) in infants who received MV over 24 h. MATERIALS AND METHODS: All infants who received MV for more than 24 h in the last year were enrolled in the study. Demographic data included age, gender, weight, and admission diagnosis. Heart rate, respiratory rate, blood pressure, and oxygen saturation were measured during MV, 2 h after the nasotracheal Mapleson D CPAP system and 2 h after extubation. Patients were classified into two groups: patients MV more than 48 h, and patients with MV fewer than 48 h. P < 0.05 was considered statistically significant. RESULTS: A total of 50 children were enrolled in the study, with a median age was 34 ± 45 months (range, 1-59 months) and median weight was 11.98 ± 9.31 kg (range, 1-48 kg). Median duration of MV was 480 h (range, 2-570). There were no significant differences in PaO2, PaCO2, and pH among MV, 2 h after the nasotracheal Mapleson D CPAP system and 2 h after extubation and spontaneous ventilation with the nasopharyngeal Mapleson D CPAP system or with nasal prongs. The overall extubation failure rate was 26% (n = 13). Weight and age were significantly associated with extubation failure (P < 0.05). CONCLUSIONS: The Mapleson D CPAP system, in our opinion, is a useful and safe alternative to more complex and expensive noninvasive CPAP and BiPAP weaning from MV in infants.

Low-dose spinal anesthesia for urgent laparotomy in severe myasthenia gravis.

Myasthenia gravis (MG) is an autoimmune disease with an incidence of 2-10/100,000 cases per year, characterized by muscle weakness secondary to destruction of postsynaptic acetylcholine receptors. In these patients, important perioperative issues remain unresolved, namely, optimal administration of cholinesterase inhibitors, risks of regional anesthesia, and prediction of need of postoperative mechanical ventilation. We describe the use of a low-dose spinal anesthesia in a patient with MG who was submitted for emergence exploratory laparotomy. The utilization of low-dose spinal anesthesia allowed us to perform surgery with no adverse respiratory or cardiovascular events in this patient.